Pelvic Care

Bladder and bowel dysfunction

Incontinence is the accidental or involuntary loss of urine from the bladder (urinary incontinence), or bowel motion (faeces) or wind (flatus or flatulence) from the bowel (faecal or bowel incontinence).

Different types of incontinence include:

• Stress incontinence is leakage from the bladder or bowel during physical exertion or effort (such as coughing, sneezing, laughing, exercising, walking or when lifting).
• Urgency is a sudden, compelling desire to go to the toilet which is difficult to defer. Urge incontinence is accidental loss of urine or faeces associated with urgency.

• Other Symptoms

  • Going to the toilet often (frequency), rushing to the toilet (urgency), going to the toilet frequently at night (nocturia) are also bladder and bowel problems.
  • Difficulty emptying your bladder or bowel such as a feeling of incomplete emptying, needing to strain or use your hands/fingers to assist are also signs of dysfunction.
  • Haemorrhoids, anal fissures, and rectal prolapse are other bothersome issues.

• Treatments

  There is compelling evidence that physiotherapy is effective and should be first-line treatment for incontinence. Treatment for bladder and bowel issues usually involves more than just pelvic floor muscle training. Other management strategies include:

  • Education on good bladder and bowel habits
  • Bladder retraining and calming
  • Electrical stimulation and TENS
  • Education and strategies for correct voiding and defecation
  • Education to help you optimise the consistency and frequency of your bowel actions

Pelvic Organ Prolapse

Your bladder, bowel and uterus are all organs of your pelvis. Pelvic organ prolapse occurs when one or more of these organs bulges against, or sags down into the vagina, creating a bulge.

• Symptoms

  • Sensation of heaviness, dragging or bulging inside your vagina, often made worse with physical activities or long periods of standing
  • You may be able to feel a lump bulging outside your vagina (often noticed when washing or wiping)
  • Difficulty emptying the bladder or bowel
  • Less control with your bladder or bowels
  • Pain, discomfort or less sensation with sexual intercourse
  • Low back or pelvic pain
  • Difficulty using tampons

• Risk Factors

  Pelvic organ prolapse occurs when the supportive ligaments of the pelvis and pelvic floor muscles become stretched or too weak to hold the organs in the correct place. This stretching/weakening can occur with:

  • Pregnancy and childbirth
  • Menopause and ageing
  • Being overweight
  • Chronic constipation
  • Chronic coughing
  • Heavy lifting
  • Genetic factors – a woman is at greater risk of prolapse if her mother or sister has a prolapse
  • Joint hypermobility

• Treatments

  There is strong evidence for physiotherapy management of prolapse. Simple lifestyle changes can significantly improve the symptoms of prolapse and can prevent it from getting worse. Management may include:

  • Identification and modification of factors that may be aggravating your symptoms
  • Pelvic floor muscle training
  • Bladder and/or bowel management
  • Addressing lifestyle factors such as physical activity, sleep, diet and stress
  • A plan for self-management is the key to long term success
  • Pessary

Pelvic and sexual pain

Persistent pelvic pain can present as painful periods (dysmenorrhoea), pain with sexual intercourse (dyspareunia), vaginismus, coccyx pain (coccydynia), vulval pain (vulvodynia), irritable bowel syndrome (IBS), endometriosis, bladder pain syndrome, interstitial cystitis, pudendal neuralgia and anal pain.

Up to one in five women between the age of 18-50 experience persistent pelvic pain.

• Risk Factors

  • Episiotomy or tears
  • Vaginal delivery or c-section
  • Pelvic or abdominal surgery
  • Hormonal changes
  • Endometriosis and other persistent pelvic pain conditions
  • A history of sexual abuse

• Treatments

  ‘Overactivity’ refers to pelvic floor muscles that are tense and do not relax or may contract when they should relax for example when urinating, defecating or during sexual intercourse.

  75% of women who suffer from persistent pelvic pain have pelvic floor muscle tension which is likely contributing to their symptoms.

  To assist with your pain management, you may learn how to ‘down train’ your pelvic floor muscles. Your physiotherapist will first teach you about your pelvic floor muscles and how to relax them. There are many ways in which your physiotherapist can teach you how to do this. Some examples are:

  • Relaxation and breathing techniques
  • Visual and tactile feedback of pelvic floor muscle contraction and relaxation
  • Graded exposure therapy i.e. guided dilator therapy
  • Self-management techniques i.e. self-massage, stretches and exercises.

  Persistent pelvic pain is often associated with bladder, bowel and sexual dysfunction. As part of your management, we help you to address these issues.

  Psychosocial factors (emotional, behavioural, cognitive responses) or predisposing factors (genetics, general health, past experiences) can contribute to the persistence of pain. Your physiotherapist may help you to address some of these factors in conjunction with other health professionals such as your GP and clinical psychologist.

  At Subiaco Women’s Health we understand that everyone’s pain experience is different and requires an individualised approach. We want to empower you by helping you understand your pain and provide you with a toolkit so that you can manage your pain with confidence. Your physiotherapist will therefore take the time to get to know you as person, your pain experience and work with you to achieve your goals.